Browsing by Author "Nwankwo, Gideon Ikemdinachi"

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    Effect of cumulative exposure to media channels for malaria messages on knowledge of malaria prevention among women (15– 49 years) in Uganda
    (Springer Nature, 2026-05-05) Natuhamya, Charles; Obiora, Rejoice Uche; Nwankwo, Gideon Ikemdinachi; Agbi, Delight Mawufemor; Isiko, Isaac; Mwebesa, Edson
    Introduction Malaria remains a leading global public health concern, disproportionately affecting populations in low-resource settings. Uganda continues to contribute substantially to the global malaria burden, yet exposure to malaria-related health messages remains limited. In recent years, diverse media platforms have been adopted to disseminate prevention messages. This study assessed the influence of cumulative exposure to malaria message media channels on knowledge of malaria prevention and its associated factors among women of reproductive age in Uganda. Methods We conducted a secondary analysis of the 2018–2019 Uganda Malaria Indicator Survey (UMIS), comprising 7124 women aged 15–49 years selected using a two-stage cluster and stratified sampling design. Knowledge of four prevention methods recommended by World Health Organization (WHO), bed nets, insecticide-treated nets (ITNs), preventive medicine, and indoor residual spraying (IRS) was assessed. Associations between cumulative media exposure and malaria knowledge were examined using t-tests, margins analysis, and mixed-effects negative binomial regression models. Results Knowledge of malaria prevention was unevenly distributed: 76.5% of women reported awareness of bed nets, compared with only 9.1% for ITNs, 6.2% for preventive medicine, and 4.3% for IRS. Cumulative exposure to media channels was significantly associated with knowledge of ITNs (p < 0.001), preventive medicine (p = 0.002), and IRS (p < 0.001), but not bed nets. Education, age, wealth, residence, and region were significant determinants of exposure to media channels. Women with secondary or higher education were nearly twice as likely to report exposure to multiple channels compared to uneducated women (Incidence Rate Ratio, IRR = 1.86; 95% Confidence Interval, CI 1.59–2.17). Similarly, women aged ≥ 40 years were 69% more likely (IRR = 1.69; 95% CI 1.35–2.11) to report exposure to multiple channels than those under 20 years. In contrast, rural and refugee women reported significantly lower exposure relative to urban residents (IRR = 0.77 and 0.28, respectively). Conclusions Cumulative multi-channel exposure to malaria prevention messages significantly improves women’s knowledge of ITNs, preventive medicine, and IRS. However, structural inequities in education, wealth, and place of residence limit access to diverse channels. Integrated, context-specific, and equity-focused communication strategies are essential to broaden awareness beyond bed nets and to accelerate progress toward malaria control and elimination in Uganda.
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    Women’s decision-making autonomy and early antenatal care initiation in Ghana: a propensity score-matched analysis
    (Springer Nature, 2026-03-03) Agbi, Delight Mawufemor; Nwankwo, Gideon Ikemdinachi; Mawuko, Courage Venunye; Iha, Daniel Thoya; Djossou, Josias Ounsinli; Mwebesa, Edson
    Introduction Women’s decision-making autonomy is widely recognized as an important determinant of maternal health behaviors such as the timing of antenatal care (ANC) initiation in low- and middle-income countries. However, empirical evidence from Ghana on this relationship, particularly using causal inference approaches, remains limited. This study investigates the effect of women’s decision-making autonomy on the early initiation of ANC visits in Ghana. Methods Data were sourced from the 2022 Ghana Demographic and Health Survey (GDHS), including 4,314 women aged 15–49 years with a birth in the preceding three years before the survey. Autonomy was measured as a composite index from household decision-making participation. Propensity Score Matching (PSM) was used to match women with High and None/Low autonomy, based on covariates like age, education, wealth, and residence. The average treatment effect on the treated (ATT) was estimated to assess the impact of high autonomy on early ANC initiation (within the first trimester), compared to the counterfactual scenario in which the same women lacked such autonomy. Results Among the women included in the study, 25.3% reported high decision-making autonomy, and 66.4% initiated ANC early. Women with high autonomy were more likely to be older (30–49 years), educated (secondary or higher), married, employed, Christian, insured, urban residents, and from wealthier households. After matching on socio-demographic covariates, no statistically significant effect of high autonomy on early ANC initiation was observed [-0.029; 95% CI: -0.081 to 0.022]. Conclusion Women’s decision-making autonomy, when measured through household decision-making participation and within the Ghanaian context, does not independently drive early ANC initiation, suggesting that broader structural and contextual barriers may constrain the translation of autonomy into early care-seeking.